Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Andrew D Petersen, DO

Individual provider Family Medicine Physician · NPI 1124011572

Andrew D Petersen, DO is a Family Medicine Physician in Provo, Utah. Licensed in Texas and Utah. Registered with an NPI since 2005.

Licensed in
TX, UT
In the registry since
2005
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

524 W 300 N Ste 203
Provo, UT 84601-2669
Phone: (801) 607-5268
Fax: (801) 607-5271
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 8382699-1204 (UT)
Family Medicine Physician Taxonomy 207Q00000X · Licence M4441 (TX)

Record details

NPI number1124011572
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedAugust 31, 2005
Last updated in NPPESMay 21, 2014
Mailing address524 W 300 N Ste 203, Provo, UT 84601-2669

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